The 81-year-old Democrat has until now led a tightly disciplined White House with little of the merry-go-round of staff changes seen under Donald Trump, his predecessor and likely rival in a November rematch.
Yet Biden now faces uncomfortable questions about his credibility as commander-in-chief of the world's top military, and mounting calls to sack Defense Secretary Lloyd Austin, who twice went unannounced into hospital as Washington grapples with foreign crises in Israel and Ukraine.
So far, Biden has resisted taking action over the 70-year-old Austin's vanishing act, but the White House has launched an urgent review of its chain-of-command procedures as it grapples to contain its worst cabinet crisis to date.
The row also risks making Biden -- who has portrayed himself as a leader in contrast to a chaotic and undemocratic Trump in speeches this past week -- look like he has lost control of his top team, at a time when Republicans are already painting him as too old to manage the job.
"The dereliction of duty here is so serious that it ought to require Austin's immediate resignation," conservative columnist Bret Stephens said in The New York Times.
"What's astonishing here isn't that Austin neglected to inform his staff or the White House. It's the nonchalance with which the administration is treating the incident."
- 'Suboptimal' -
The White House has admitted the affair is "suboptimal," but amid repeated questions at daily briefings it insists that Biden still has confidence in Austin.
Yet the timeline is damning, particularly regarding what the president knew about the whereabouts of the man who is directly below him in the military chain of command, and sixth in the presidential line of succession.
Career soldier Austin, who is known to closely guard his privacy, was diagnosed with prostate cancer in early December and had surgery under general anesthetic on December 22. He was then hospitalized on January 1 with complications from a urinary tract infection, and is still receiving treatment.
Extraordinarily, the White House was not informed about the hospitalization until January 4. And it was not until Tuesday this week that Biden was finally told of the full story including the cancer diagnosis.
The Pentagon insisted that Austin took part in calls from hospital, while key decisions were being made to contain fallout from the Israel-Hamas war, which has sparked violence against US forces in Iraq and Syria as well as attacks on international shipping in the Red Sea.
A Baghdad strike against a pro-Iran militia commander was approved before the hospitalization, it said.
That has not convinced Republicans who are now threatening Austin with impeachment, the latest Biden administration official they are targeting in a bid to hammer the Democrats ahead of November's election.
The affair has drawn friendly fire too.
Democrat Jack Reed, chairman of the Senate Armed Services Committee, said he was "concerned that vital chain of command and notification procedures were not followed."
He called for "accountability and transparency" from the Pentagon and said the "lack of disclosure must never happen again."
On Wednesday, Democratic Representative Chris Deluzio became the first from his party to demand Austin's resignation, saying, "I have lost trust."
But unlike the endless "you're fired" of the turbulent Trump administration, Biden has repeatedly been unwilling to sack senior officials. He notably clung to National Security Advisor Jake Sullivan after the chaotic US exit from the Afghanistan in 2021.
Asked by AFP on Wednesday if the White House was confident Austin was up to speed, after he took part in a call with Biden the day before on the Red Sea attacks, National Security Council spokesman John Kirby said simply: "Yes."
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